Medicare Compliance & Reimbursement

Heads up: The government may be dabbling with your medical records.

Head up, providers. If a new proposed rule goes through, your Medicaid claims could be subjected to more state oversight. Will your compliance plan have you covered?

The Centers for Medicare & Medicaid Services said Aug. 27 it wants to use a new technology-based approach to determine the payment error rate for the Medicaid program, similar to the Comprehensive Error Rate Testing Program for Medicare. The rule would require states to review a sample of Medicaid claims every year. 

Here's what else is on the new fraud-fighting agenda: Back to basics: CMS says it plans to emphasize more provider education of Medicare and Medicaid rules. Tighter grip on drug cards: CMS has contracted with program safeguard contractor IntegriGuard to do a weekly assessment of drug card sponsor's drug pricing information to prevent "bait and switch" tricks, as well as counterfeit card and identity theft schemes. Fraud "hot spots" will get hotter: Areas of repeated fraud can expect more concentrated scrutiny. Medi-Medi match program expands: Providers in Ohio and Washington will be next to join a growing list of states that have their Medicare and Medicaid claims data analyzed together to root out "time bandits" - providers who bill for a more than 24 hours in a day in both programs. Compliance program "best practices": Which auditing and monitoring activities are having a tangible impact on your billings? A pilot project will attempt to define - and make public - the most effective compliance tactics.

The proposed rule, which is open for public comment until Sept. 27, can be found at
http:// http:// http://www.access.gpo.gov/su_docs/fedreg/a040827c.html.